Why the study?
Pain intensity is difficult to precisely assess due to its subjective nature, prompting the investigation of heart rate variability as a potential parameter to evaluate the pain-relieving effect of low-frequency TENS.
Does low-frequency TENS alter heart rate variability and improve pressure pain thresholds in athletes with acute musculoskeletal injury?
Does low-frequency TENS alter heart rate variability and improve pressure pain thresholds in athletes with acute musculoskeletal injury?
Low-frequency TENS increases pressure pain thresholds and shifts sympathovagal balance toward the sympathetic domain (increased LF/HF ratio) in athletes with acute musculoskeletal injury.
HRV may aid objective pain assessment with TENS in athletes; leaves open whether it reliably tracks relief in controlled trials.
Background: Pain is a relevant clinical symptom to ask for medical management. Since pain is a subjective sensation, its intensity is difficult to precisely assess. Objectives: The present study aimed to determine whether heart rate variability (HRV) can be a potential parameter to evaluate the pain-relieving effect of low-frequency transcutaneous electrical nerve stimulation (TENS). Methods: Athletes with lower limb musculoskeletal injuries were voluntarily included in the study. Pressure pain thresholds (PPT) was measured immediately after the intervention, and 24 hours after the treatment. Heart rate variability was also determined from electrocardiography (ECG) monitoring throughout the intervention. Results: The HRV of 25 participants revealed that 30 minutes of low-frequency electrical stimulation immediately increased PPT (before = 2.67 ± 0.79; after = 2.92 ± 0.90, P = 0.011). Thirteen participants had more than a 10% increase in PPT after the intervention; nevertheless, three participants had a decrease in PPT. The PPT was returned to the baseline 24 hours after the intervention. Electrocardiography demonstrated that only the frequency domain of low frequency-high frequency (LF/HF) ratio was significantly increased after the intervention (before = 1.454 ± 0.739; after = 1.922 ± 1.378; P = 0.035) but not time-domain HRV. Time-domain HRV significantly decreased during the intervention before returning to the baseline. The correlation between the change in PPT is mostly correlated with LF/HF. Conclusions: Heart rate variability revealed the potential change in sympathovagal balance toward the sympathetic domain during low-frequency TENS intervention. The frequency-domain LF/HF ratio was the most sensitive parameter to be affected by pain.
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Bootkunha et al. (2023) studied this question.
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